Forms
Below is a list of AGED’s most common trust forms. While we prefer that you come in the office to discuss your trust needs, some people like to prepare their own documents, or fully review the forms before their meeting.
Click the link to below to jump to the particular forms you are interested in.
- Instructions
- The Florida Public Guardianship Pooled Special Needs Trust
- Pooled Trusts d(4)(c)
- Third Party Trusts
- Group Home and Discounted Nursing Home Medicaid Documents
- Guardianship Benevolent Fund
- Additional Documents – Medicaid and Other Related Documents
These documents are available in PDF format, making it easy to download and print. If you do not have a PDF reader on your computer, you may download one here: Free Adobe Reader.
Instructions
Documentation Needed to Establish a Trust with AGED
AGED Medicaid Documentation Checklist
How to Read Your Trust Statement guide
Making Deposits Into a Client’s Special Needs Trust Account *Please call AGED at (407) 682-4111 to obtain deposit instructions*
The Florida Public Guardianship Pooled Special Needs Trust
AGED has been named the Administrative Trustee for the Florida Public Guardianship Pooled Special Needs Trust. Click here to access the documents for this trust.
AGED d(4)(C) Pooled Trust Documents
Documentation Needed to Establish a Trust with AGED
AGED d(4)(C) Pooled Master Trust Agreement
AGED d(4)(C) Pooled Fee Agreement (Fillable)
AGED d(4)(C) Joinder Agreement (Fillable)
Instructions for Completing Pooled SNT Joinder Agreement
Disbursement Request Form (Fillable)
Authorization to Disclose Information to a Third Party Individual or Firm (Fillable)
Sample Petition and Order Authorizing Guardians to Establish a Pooled Trust
Authorization for Direct Transfer VIA ACH
Disclaimer Regarding Transfers to Pooled Trust for SSI Recipient Age 65 or Older
Disclaimer Regarding Legal Advice
AGED Third Party Trust Documents
Documentation Needed to Establish a Trust with AGED
AGED Signed Third Party Master Trust Agreement
AGED Third Party Fee Agreement (Fillable)
AGED Third Party Joinder Agreement (Fillable)
Disbursement Request Form (Fillable)
Authorization to Disclose Information to a Third Party Individual or Firm (Fillable)
Authorization for Direct Transfer VIA ACH
AGED Group Home and Discounted Nursing Home Medicaid Account Documents
Important Note: AGED’s Discounted Fee Agreement for Nursing Home Medicaid is for individuals in a Nursing Home placing income only and/or less than $5,000 in assets into the trust. If assets are above $5,000 please use AGED’s d(4)(C) Pooled Trust Documents.
Documentation Needed to Establish a Trust with AGED
AGED Group Home Fee Agreement (Fillable)
AGED Discounted Fee Agreement for Nursing Home Medicaid (Fillable)
AGED Discounted Nursing Home Medicaid / Group Home Joinder Agreement (Fillable)
Disbursement Request Form (Fillable)
Authorization to Disclose Information to a Third Party Individual or Firm (Fillable)
Authorization for Direct Transfer VIA ACH
AGED Guardianship Benevolent Fund Documents
Guardianship Benevolent Fund Application (Fillable)
Guardianship Ben Fund Instructions 01-12-2023
Guardianship Benevolent Fund Disbursement Request Form (Fillable)
Do you need additional information not located on this page? Feel free to contact us anytime with any questions you may have.
Florida Adaptive Sports
A program of AGED, Florida Adaptive Sports is a social sports club that helps keep disabled Floridians of all ages healthy for life by providing an outlet for friendship and activity.
